Roughly 4 percent of American children experience the death of a parent before age 15. They often struggle to cope with their loss — and as many as one-third of bereaved children suffer from major depression for a year afterward.
For children grieving lost loved ones, Rene Searles McClatchey offers a surprisingly effective treatment: summer camp.
The University of Georgia social work researcher developed Camp Magik to help children cope with grief by pairing traditional camping activities, such as canoeing, with intensive therapy. Her studies indicate kids' mental health improves during the three-day program.
Most children don't grieve the way adults do partly because they have a different understanding of what death means: Preschool kids may see it as reversible, elementary-grade children may still believe that no one they know will die, and many engage in "magical thinking" — expecting they can save a loved one who's chronically ill.
Researchers have discovered that, much like military veterans, children often display post-traumatic stress symptoms — they re-experience the event or avoid thoughts that remind them of the trauma. Some young children may regress, returning to behaviors like thumb-sucking. For others, the trauma blocks them from progressing through normal stages of grief, even with a counselor's help.
"Part of grief work is to process pleasurable moments and memories of your loved one. That's hard to do if all you can think about is how they died," McClatchey said.
The phenomenon of "childhood traumatic grief" was first associated with children whose parents died violently — such as those who perished in the 9/11 attacks. Yet research by McClatchey and others shows that children may be just as traumatized by an "expected" death, such as from cancer, as by an unforeseen one. For kids, any death can come as a shock, and watching a parent suffer through a long illness can be as traumatizing as the event itself.
Few psychology researchers examined traumatic grief among children until the past several years. "Because bereavement is ubiquitous, the assumption was that whatever reaction a child had was a normal and healthy reaction," said St. John's University professor Elissa Brown.
Usually, counselors and other social work professionals in schools, hospitals, government agencies and nonprofit bereavement centers aid kids in coping with loss. Yet most are unaware of research into treatments that focus on trauma.
Significant government funding beginning early this decade, along with renewed interest after 9/11, has brought psychiatrists and psychologists together with social workers — they're now adapting psychologists' techniques for treating adult post-traumatic stress to social workers' long-standing grief programs. "We're merging two separate literatures that up until the last five years hadn't spoken much to each other," said Anthony Mannarino, co-founder of Allegheny General Hospital's Center for Traumatic Stress in Children and Adolescents.
He and research partner Judith Cohen have treated children with trauma-focused cognitive behavioral therapy, a method aimed at changing behaviors and thought processes. Several pilot studies have helped kids overcome post-traumatic stress to deal with losing a parent, or other traumatic events such as sexual abuse, in a healthier manner.
When McClatchey founded Camp Magik outside Atlanta in 1995, she built the activities around standard grief work, such as helping children understand the reality of the loss. After a few years, she started graduate school at the University of Georgia and began testing the outcomes among campers. Unfortunately, the kids weren't improving much during camp.
She decided to integrate trauma-focused therapies while maintaining grief work and group activities, such as putting on plays with storylines related to the kids' lives.
The new format made a difference. As described in a recent paper with M. Elizabeth Vonk of University of Georgia and Gregory Palardy of University of California, Riverside, the numbers demonstrated a clinically significant drop in symptoms of post-traumatic stress and severe grief. (How their parents died had little effect on improvement). McClatchey saw the changes herself between the Friday when the children showed up and the Sunday when they left — one child hadn't spoken during the previous year but arrived home from camp talking.
Camp Magik, which has thus far served more than 1,500 kids, could prove to be the shortest and most cost-effective among research-tested treatments for childhood traumatic grief. Compared to weekly therapy, which typically costs $100 per hour and may last months, the foundations that pay for the camp sessions spend about $250 per camper for a three-day weekend.
It now runs out of three sites in Georgia, and McClatchey plans to expand. She's informally advising camp directors around the country hoping to use similar techniques.
At the same time, the Allegheny team has received government grants to train hundreds of clinicians in trauma-focused therapy, and Cohen is consulting for a camp and seminar for children and families of fallen soldiers.
Funding to train therapists is not unlimited, though programs like McClatchey's — which rely on both practicing clinicians and less experienced co-counselors — might lower costs. For now, the researchers are telling any clinician who will listen about their traumatic-grief model and successful experiments. If they're successful, camp directors and bereavement counselors won't have to get a Ph.D. (as McClatchey did) to help children.
"You don't have to do the science, but you can go find it," Brown said. "Then you can implement it."
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